Pulmonology

Question 1

best initial test in acute asthma exacerbation?

Answer 1

PEF or ABG

Question 2

What is the most accurate diagnostic test for asthma when the patient is asymptomatic?

Answer 2

20% decrease in FEV1 with use of methacholine or histamine as they provoke bronchoconstriction and an increase in bronchial secretions

Question 3

What is the best indication of the severity of an asthma exacerbation?

Answer 3

Respiratory Rate
(pulse ox will not show hypoxia until point of resp failure) 
(O2 sat can be maintained >90% by hyperventilating)

Question 4

how to quantify severity of asthma attack?

Answer 4

PEF

ABG

Question 5

Treatment for asthma exacerbation

Answer 5

oxygen
albuterol
steroids
Mag (only in acute severe episodes not responsive to albuterol)

Question 6

Best initial test to diagnose COPD

Answer 6

chest x-ray

Question 7

why is their an increase in TLC in COPD

Answer 7

increase in residual volume

Question 8

how do you define full reversibility to bronchodilators in obstructive airway disease?

Answer 8

> 12% or 200ml increase in FEV1

Question 9

CBC findings and EKG findings that might be seen with COPD

Answer 9

CBC: increase in hct from chronic hypoxia

EKG: right atrial hypertrophy and right ventricular hypertrophy. afib. MAT

Question 10

most effective symptomatic therapy in COPD?

Answer 10

tiotropium, ipratropium

Question 11

when all medical therapy is insufficient for COPD, what do you do?

Answer 11

refer for transplant

Question 12

single most common cause of bronchiectasis?

Answer 12

cystic fibrosis

Question 13

key to the diagnosis of bronchiectasis?

Answer 13

recurrent episodes of very high volume purulent sputum production.

can have hemoptysis
weight loss
anemia of chronic disease
crackles
dyskinetic cilia syndrome

Question 14

best initial test and most accurate test to diagnose bronchiectasis?

Answer 14

high-resolution CT scan

Question 15

Treatment for bronchiectasis

Answer 15

specific microbio diagnosis is preffered since mycobacterium avium intracellulare can be found

chest physiotherapy
rotate antibiotics

Question 16

Asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on c-xray

Answer 16

allergic bronchopul aspergillosis

Question 17

treatment for ABPA?

Answer 17

Oral steroids for severe cases (inhaled dont work)

Itraconazole for recurrent episodes

Question 18

PFTS for CF?

Answer 18

mixed obstructive and restrictive. and decreased diffusing capacity for CO

Question 19

COPD pneumonia pathogen?

Answer 19

H.flu

Question 20

Recent viral infection -> pneumonia. pathogen?

Answer 20

S. aureus

Question 21

Hoarseness and pneumonia?

Answer 21

Chlamydia pneumonia

Question 22

animals at time of giving birth. vets. farmers. type of pneumonia?

Answer 22

coxiella burnetii

Question 23

when can you consider a sputum gram stain “adequate”?

Answer 23

more than 25 wbcs and fewer than 10 epithelial cells

Question 24

Diagnostic test for PCP pneumo?

Answer 24

bronchoalveolar lavage

Question 25

diagnostic test for coxiella burnetti?

Answer 25

rising serology titers

Question 26

legionella diagnostic test

Answer 26

urine antigen, culture on charcoal-yeast extract

Question 27

treatment for pneumonia in a prev healthy, no comorbidity, mild symptoms, no abx in past 3 months?

Answer 27

azithromycin or clarithromycin or doxycycline

Question 28

treatment for pneumo if patient has comorbidities or abx in past 3 months?

Answer 28

levofloxacin or moxiflox

Question 29

single factor reasons to hospitalize a patient with pneumonia?

Answer 29

1. hypoxia 2. hypotension 3. resp > 30, PO2<60, pH <7.35 4. BUN > 30, Na <130, gluc > 250 5. HR > 125 6. confusion 7. temp > 104 8. Age > 65 or other comorbidities

Question 30

CURB 65`

Answer 30

``` (0-1 point = home) 2 or more = admit confusion uremia resp distress BP low age >65 ```

Question 31

dangerous side effect of imipenem?

Answer 31

can cause seizures. cleared renally

Question 32

best abx for lung abscess coverage?

Answer 32

clinda or penicillin

Question 33

if you get negative sputum stain for PCP testing, what should u do next?

Answer 33

bronchoscopy

Question 34

If LDH is normal, can the pneumonia be due to PCP?

Answer 34

on the test- do NOT answer PCP

Question 35

how do you define severe PCP pneumonia? what should you add for coverage?

Answer 35

PO2 <70 or A-a gradient >35 | add steroid

Question 36

If bactrim is not acceptible for PCP treatment use?

Answer 36

clinda and primaquine- (also contraindicated in G6PD) or pentamidine

Question 37

If there is a rash or neutropenia from TMP-SMX in prophylactic treatment of PCP - use?

Answer 37

atovaquone or dapsone-> (also contraindicated in G6PD)

Question 38

all of TB drugs cause hepatotoxicity. but do not stop them unless transaminases rise to - ?

Answer 38

3-5X upper limit of normal

Question 39

when are steroids helpful in TB?

Answer 39

reduce risk of constrictive pericarditis in those with pericardial involvement. decrease neuro comp with TB meningitis.

Question 40

pyrazinamide and streptomycin are contraindicated in?

Answer 40

pregnant patients

Question 41

SE of pyrazinamide

Answer 41

hyperuricemia

Question 42

If first PPD is negative in a patient with first time screen?

Answer 42

Need another test to rule out false-negative

Question 43

Does previous BCG vaccine have any effect on recommendations for positive PPD?

Answer 43

NO- still must take isoniazid for 9 months

Question 44

when you have a high suspicion for malignancy of a solitary pulm lesion- what should u do?

Answer 44

resect it. dont biopsy (high chance of false negative)

Question 45

bronchoalveolar lavage shows an elevated level of helper cells in?

Answer 45

sarcoidosis

Question 46

drug of choice for sarcoid?

Answer 46

prednisone

Question 47

Cxray in PE usually show? most common abnormality?

Answer 47

(usually normal in PE) | atelectasis, wedge shaped infarct

Question 48

most common EKG abnormality seen for PE?

Answer 48

tachy, nonspecific ST changes

Question 49

most common wrong answer "the most common PE EKG findings"?

Answer 49

S1Q3T3

Question 50

when should V/Q be first diagnostic test for PE?

Answer 50

pregnancy

Question 51

when is direct thrombin inhibitor the answer for PE?

Answer 51

HIT (fondaparinux can be used)

Question 52

Is ASA ever the answer for PE?

Answer 52

no

Question 53

Treatment of idiopathic Pulm htn?

Answer 53

prostacyclin analogues: (PA vasodilators): epoprostenol, treprostinil endothelin antagonist: bosentan phosphodiesterase inhibitor: sildenafil